Schizophrenia

The word schizophrenia sounds complicated and is in many ways a terrifying word. It needs to be said right off that schizophrenia has nothing to do with a split personality.

Schizos means split into many parts – this is supposed to illustrate the fact that the various parts of the brain have trouble communicating with one another. And phrenos means mind or brain. A good synonym in plain English is “serious confusion”. This confusion causes a person with the condition to suffer anxiety and depressions and have serious difficulty distinguishing between himself and the outside world. It may mean, for example, that a person’s own thoughts can sound like voices from outside (hallucinations) or that peculiar meanings are given to what a person says or does (delusions). Another example of this diminished capacity to distinguish what is me and what is my surroundings is that the patient can be uncertain of whether it is him who is talking when someone is reporting something on the radio or on TV, or when someone laughs far away.

Schizophrenia is not an illness in the traditional sense, but a syndrome. A syndrome means a collection of symptoms that together constitute a specific disorder.

Schizophrenia is probably not just one, but a collection of serious mental disorders – which can be treated.

Schizophrenia is rare – as rare as juvenile diabetes (so-called type 1). We expect to get 5–10 new cases per 100,000 inhabitants per year. In other words: in a city the size of Stavanger, we see 5–10 young people each year who develop a type of schizophrenia.

At some point in their lives, around 5–10 of 1,000 will be affected. That schizophrenia is both rare and common appears to be a contradiction. Even though we see new cases each year, it is unfortunately the case that in around 25% of cases the condition becomes chronic. As we have written an earlier chapter “Symptoms and signs”, we believe that this may be because we are still too late in starting treatment and we are insufficiently vigilant with regard to preventing relapses. For young people in Norway today who are on the verge of developing psychosis, it takes up to three years before receiving treatment by a psychologist or psychiatrist. We know that if we manage to shorten the duration of untreated psychosis, i.e. the time it takes from the illness begins to manifest itself until treatment starts, the prognosis improves considerably. Sometimes we can prevent it from becoming psychosis. For that reason the big challenge for the mental health sector in coming years is this: trying to get people to seek treatment sooner.

We are now beginning to understand that schizophrenia in its chronic form may be an expression of the treatment at the onset of illness being inadequate. We also think that it may be possible to prevent the development of a disorder like schizophrenia. However, the research on this is still in its infancy.

The symptoms of schizophrenia appear to vary from person to person. However, most of those affected will have problems thinking clearly and logically, and they will in any case experience some of the symptoms described earlier. Symptoms such as delusions and hallucinations become more serious the longer the illness is allowed to remain untreated. It is therefore vital to seek help quickly when problems like the ones described here appear.

Basic symptoms of psychosis are:

Diminished capacity to distinguish between self and outside world.

Other symptoms:

confused thinking

delusions

hallucinations

low motivation

emotional changes

Some persons with schizophrenia will not have all the symptoms, whereas others will be more severely afflicted.

Although the illness can arise suddenly and dramatically, it often follows a confusing period of a gradual change in behaviour and personality. The determinative symptoms of schizophrenia may not appear for months or even years.

The symptoms commonly associated with the illness are those more active and noticeable, such as e.g. hearing voices that others cannot hear or believing that one has a special mission to fulfil. These are called positive symptoms, because they are something that the illness has added to the person’s normal behaviour.

When the illness results in characteristics disappearing from a person’s normal behaviour, this is called having negative symptoms. For example, lying in bed all day owing to lack of motivation or withdrawing from people and things that a person previously enjoyed, such as going out dancing or to the cinema. Negative symptoms are harder for outsiders to notice, but they are as much of a strain and cause for worry as the positive ones. As the negative symptoms are not always seen as caused by the illness, they can be exasperating for others. It’s tempting to imagine that shaking the person or giving him a swift kick would help. Unfortunately it’s not that simple.

Dealing with these symptoms is no simple matter, but you can always be of assistance. The symptoms have a lot in common with signs of depression and may be understood as a sign of resignation or a feeling of despair.

It is the opinion of this author that the word schizophrenia is old-fashioned and of very little use in our day and age and that it should be tossed onto the scrap heap. It tells us too little about what the individual person’s particular problem is: people who get this diagnosis are more like you and me than they are different, and they are as different as you and me.*